Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review

Abstract

The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their adverse effects on health, with a growing user base targeting young people. This systematic review aimed to describe the adverse effects on the respiratory system in consumers of these devices. We conducted a systematic review and bibliometric analysis of 79 studies without conflict of interest evaluating ENDS and HTP effects in the respiratory system in experimental models, retrieved from the PubMed database. We found that the damage produced by using these devices is involved in pathways related to pulmonary diseases, involving mechanisms previously reported in conventional cigarettes as well as new mechanisms particular to these devices, which challenges that the tobacco industry’s claims. The present study provides significant evidence to suggest that these devices are an emerging public health problem and that they should be regulated or avoided.

Passive Smoking Is Associated with Multiple Heavy Metal Concentrations among Housewives in Shanxi Province, China

“…However, alternative tobacco products are rarely used among adults in China, especially among those living in rural areas [ 37 ]. Waterpipe tobacco and electronic cigarettes have been identified to cause lung damage in recent years [ 38 ]. More research is needed for the subdivided fields to supplement the relevant gaps in the future.…”

Characteristics of and reasons for patients with chronic obstructive pulmonary disease to continue smoking, quit smoking, and switch to heated tobacco products

“…Current smokers have been smoking for longer (45.5±11.2 vs 38.0±12.0 years, p<0.01) and smoked fewer cigarettes per day (20.3±11.4 vs 27.3±13.0, p<0.01) than past smokers. Current smokers had milder symptoms of shortness of breath (mMRC: 1.2±0.9 vs 1.5±1.1, p=0.04), had less of an appetite (SNAQ: 14 [13][14][15] vs 15 [14][15][16] , p<0.01), were more usually living alone (34.2% vs 20.4%, p<0.01), S1). Living alone was not found to be significant after multivariable analysis but tended to be associated with current smoking (OR=1.71; 95% CI: 0.94-3.14, p=0.08).…”

“…The number of current smokers was 82 (20.0%), the average duration of smoking was 39.5±12.2 years, and the average number of cigarettes smoked per day was 25.9±13.0. The median CAT score, and mean mMRC score and predicted %FEV 1 were 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 1.4±1.1, and 64.5±23.4%, respectively. The proportion of current smokers in the families of participating patients with COPD was 11%.…”

“…The perception of a reduced health risk compared to smoking cigarettes has been reported among the reasons for selecting a specific HTP brand in Japan 13 . Although there are several reports stating that HTP and e-cigarettes may reduce the exposure to harmful substances, compared to cigarettes 14 , quitting smoking altogether is preferred due to reported adverse health effects resulting from the use of HTP and e-cigarettes [15][16][17] . One report advocated not recommending these products as a replacement for nicotine to patients who were smokers with underlying chronic respiratory diseases such as COPD, since the mechanisms of damage could facilitate the underlying immune impairment and exacerbate complications or disease progression 15 .…”

ECAM: A low-cost vaping device for generating and collecting electronic cigarette condensate for in vitro studies

“…Electronic cigarettes (ECs) are promoted by the industry as a safer alternative to conventional cigarettes; however, the long-term health impacts are not yet known. Several recent reviews summarise studies demonstrating significant evidence that the use of EC devices poses health risks [1] , [2] , [3] , [4] , [5] , [6] . ECs are electronic nicotine delivery systems that work by vapourising a liquid, known as an e-liquid, that the user inhales.…”